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Physical Therapists Are Radiant about Test Results for Neck Pain

Posted on: 01/30/2003
Physical therapists are sometimes left scratching their heads. This is the case when they try to decide which test to use to look for cervical radiculopathy (CR). CR is a disorder of the spinal nerve root as it leaves the spinal cord in the neck area.

CR is most commonly caused by a problem with the disc. The disc is the gel-like cushion between each vertebra. For example, a protruding disc may put pressure on the spinal nerve root, causing pain and other symptoms of CR. Sometimes bone spurs or tumors cause CR.

There are more than 30 tests a therapist can use to examine a patient for CR. It would be helpful to find one test or a cluster of several tests that rule out or confirm CR. A group of therapists at the U. S. Army-Baylor graduate program in physical therapy studied this problem.

They found that one test in particular was most accurate: the upper limb tension test A (ULTTA). In this test, the patient lies face up on the exam table. The therapist applies pressure to hold the scapula (shoulder blade) down while moving the arm and neck through a series of six positions.

The test can confirm that the cause of the patient's symptoms is CR. If the symptoms increase or decrease during the test, it's positive for CR. If there is no change in symptoms, then CR is probably not the patient's problem. Researchers also found that patients with a positive test for ULTTA plus two other tests may need further medical tests. Range of motion measures are also helpful.

Knowing which tests are the best predictors can help physical therapists disgnose CR early. An early diagnosis may help patients avoid more expensive and painful tests when they aren't needed.

LtCol Robert S. Wainner, PhD, PT, OCS, ECS, et al. Reliability and Diagnostic Accuracy of the Clinical Examination and Patient Self-Report Measures for Cervical Radiculopathy. In Spine. January 1, 2003. Vol. 28. No. 1. Pp. 52-62.

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